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Published byAshlyn Andrews Modified over 9 years ago
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Management of cough in lung cancer
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Clinical guidelines for the management of cough in lung cancer: report of a UK Task Group on Cough. Molassiotis A 1, Smith JA 2, Bennett MI 3, Blackhall F 4, Taylor D 5, Zavery B 6, Harle A 4, Booton R 7, Rankin EM 8, Lloyd-Williams M 9, Morice AH 10.
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Epidemiology Cough is common symptom – 23-37% of all cancer patients – 47-86% in lung cancer Not always well managed Little evidence to guide practice
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Formation of task group Literature reviews Peer review by UK committees Submitted for publication
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Pathophysiology Coughing serves to protect airway from irritants Stimuli provoke cough via vagus nerve through – chemoreceptors (C fibres) – mechanoreceptors (A delta fibres)
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In lung cancer Ulceration of mucosa – Mechanical stimulation Release of inflammatory mediators – Chemoreceptor stimulation – Sensitises peripheral nerves Also: – Obstruction – Pleural effusion – Infection – Fistulas – Carcinomatosis
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Recommendations
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Assessment History – Type of cough (productive / non-productive) – Trigger factors – Nocturnal or day time Co-morbid conditions – COPD – Heat failure No validated symptom scale available
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Assessment Drugs causing cough – Methotrexate – Bleomycin – ACE inhibitors Further investigations – ?CXR – CT
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Treat reversible causes COPD / asthma – Inhaled bronchodilators – Steroid (prednisolone 30mg daily) Infection (bronchietctasis, LRTI) – antibiotics GI reflux – PPI (omeprazole) – Metoclopramide or domperidone for non-acid reflux-
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Treat the cancer Chemo – Improves symptoms including cough External radiotherapy Brachytherapy
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Symptomatic management Linctus – Glycerol – Simple linctus Trial of steroid – Prednisolone – (or dexamethasone)
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Centrally acting agents Codeine – 30mg qds Morphine or methadone – If codeine no help – Morphine 5-10mg bd No dose response relationship for cough
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Peripherally acting agents Antitussive agents – Levodropropizine, – Moguisteine – Levocloperastine Local anaesthetic agents – nebulised bupivacaine – benzonatate
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In general Low levels of evidence for these recommendations Peripheral and intermittent approaches before central and continuous treatment In lung cancer – many patients already on opioids for pain Central approaches maximised already
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LOCAL ANAESTHETICS Nebulised Lidocaine Benzonatate PERIPHERALLY-ACTING ANTITUSSIVES Levodropropizine, Moguisteine, Levocloperastine OPIOIDS Morphine/Methadone Dextromethorphan, Codeine, Hydrocodone CANCER SPECIFIC systemic chemotherapy/RT endobronchial therapy, PDT, palliative RT CO-MORBIDITIES COPD, reflux, asthma, infections CONSIDER ORAL STEROID TRIAL 2 weeks adjunctive therapies, anxiety management and vocal hygiene techniques EXPERIMENTAL Carbamazepine, Thalidomide, Gabapentin, Baclofen Amitriptylline
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